HOARSENESS OF VOICE

DEFINITION

Hoarseness is defined as roughness of voice resulting from variations of periodicity and/or intensity of consecutive sound waves.

PRODUCTION OF NORMAL VOICE

Vocal cords should:

Be able to approximate properly with each other.

Have a proper size and stiffnessHave an ability to vibrate regularly in response to air column.

CONDITIONS CAUSING HOARSENESS

Loss of approximation as in vocal cord paralysis, fixation, tumor coming in between the vocal cords

Size of the cord which may increase in oedema of the cord or a tumor, or decrease in partial surgical excision or fibrosis

Stiffness, decreases in paralysis and increases in spastic dysphonia or fibrosis

AETIOLOGY

Causes:1. Inflammation Acute- acute laryngitis usually

following cold, influenze, exanthematous fever, laryngotracheobronchitis, diphtheria

Chronic- Specific: TB, Syphilis, scleroma, fungal infections

Non specific: Chronic laryngitis, atrophic laryngitis

2. Tumors- Benign: Papilloma, hemangioma, chondroma, fibroma, leukoplakia

Malignant: Carcinoma3. Tumor like masses- Vocal nodule,

Vocal polyp, angiofibroma, amyloid tumor, contact ulcer, laryngocoele

4. Trauma- Sub mucosal haemorrhage, laryngeal trauma, foreign bodies, intubation

PAPILLOMA

CARCINOMA LARYNX

VOCAL POLYP

4. Paralysis- paralysis of recurrent, superior laryngeal or both nerves

5. Fixation of cords- Arthritis, fixation of cricoaryetenoid joints

6. Congenital- Laryngeal web, cysts, laryngocoele

7. Miscellaneous- Dysphonia Plica Ventricularis, Mixoedema, Gout

8. Functional- Hysterical aphonia

LARYNGOCOELE

FIXATION OF CORDS

LARYNGEAL WEB

INVESTIGATIONS

1. History Mode of onset, duration of

illness, patient’s occupation, habits and associated complaints.

Any hoarseness persisting for more than 3 weeks deserves examination of larynx. Malignancy should be excluded in patients above 40 years.

2. Indirect Laryngoscopy Many of the local laryngeal

causes can be diagnosed

3. Examination of neck, chest, cardiovascular and neurological systems for laryngeal paralysis

INDIRECT LARYNGOSCOPY

4. Lab investigations and Radiological examination

5. Direct Laryngoscopy and Micro layngoscopy for detailed examination, biopsy of lesions and assessment of mobility of cricoaryetenoid joints

6. Bronchoscopy and Oesophagoscopy in cases of paralytic lesions of the cord to exclude malignancy

Thank you